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HTN Flashcards

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1
Q

MAP equation

A

(CO) x (SVR)

CO = (HR) x (SV)

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2
Q

Pre-synaptic alpha 2: _____ reduces blood pressure.

A

Stimulation

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3
Q

Alpha 1: _____ reduces blood pressure

A

Inhibition

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4
Q

Beta 2: _____ reduces blood pressure.

A

Stimulation

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5
Q

Beta 1: _____ reduces blood pressure, HR & myocardial contractility

A

Inhibition

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6
Q

RAAS _____ reduces blood pressure

A

Inhibition

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7
Q

Natrtiuretic hormone _____ decreases blood pressure

A

Stimulation

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8
Q

“Elevated” BP

A

121-129 & <80

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9
Q

Stage I HTN

A

130-139 or 80-89

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10
Q

Stage II HTN

A

> /= 140 or >/= 90

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11
Q

HTN crisis

A

> /=180 or >/= 120

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12
Q

JNC VII Cardiovascular risk factors (7)

A
  • Smoking
  • Obesity
  • Hyperlipidemia
  • DM
  • Renal insufficiency (CrCl <60ml/min or proteinuria)
  • Men >55y & women >60y
  • 1st degree relative w/ CVD (men <55y, women<65y)
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13
Q

Target organ damage (5)

A
  • Heart dz (LVH, angina/prior MI, prior stent, heart failure)
  • Stroke/TIA
  • Nephropathy
  • PAD
  • Retinopathy
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14
Q

Treatment recommendations for normal BP

A
  • Yearly eval

- Encourage healthy lifestyle to maintain BP

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15
Q

Treatment recommendations for “Elevated” BP

A
  • Re-eval 3-6 mo

- Recommend healthy lifestyle changes

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16
Q

Treatment recommendations for stage I HTN

A
  • Assess 10-yr risk for heart dz/stroke
    <10%: healthy lifestyle mods & reeval in 3-6 mo
    >10% or known CVD: lifestyle changes + 1 BP med & reeval in 1 mo
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17
Q

Treatment recommendations for stage II HTN

A
  • Lifestyle modifications + 2 BP lowering meds + reeval in 1 mo
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18
Q

BP goal for previous stroke/TIA, atherosclerosis (PAD, stable angina, ACS), CKD w/ no or A1 proteinuria, DM, general population <60 w/ no comorbidities

A

<140/90

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19
Q

BP goal for heart failure, CKD w/ A2-A3 proteinuria

A

<130/80

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20
Q

BP goal for general population >60 w/o comorbid condition

A

<150/90

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21
Q

Lifestyle mod: Na restriction

A

<2.4g/day = 2-8mmHg BP reduction

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22
Q

Lifestyle mod: DASH diet

A

Fruit, veggies, low fat dairy, reduced sat & total fat = 8-14mmHg BP reduction

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23
Q

Lifestyle modification: weight loss

A

Maintain normal body weight (BMI of 18.5-24.9) = 5-20 mmHg per 10 kg reduction

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24
Q

Lifestyle modification: physical activity

A

Aerobic activity >30 mins most days of week = 4-9mmHg reduction

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25
Lifestyle modification: ETOH moderation
Men: 2 drinks/day Women: 1 drink/day = 2-4mmHg reduction
26
Thiazide MOA
- Inhibits Na/H2O re absorption in distal tubule | - Long-term: vasodilation
27
Thiazide role in therapy
- 1st line for most pts - More effective in AA - Less effective in severe renal insufficiency - Additive/synergistic effects - Best response w/ Na restriction
28
Thiazide adverse effects
- Hypokalemia/hypomagnesemia - Hyponatremia - Glucose intolerance - Hyperuricemia - Metabolic alkalosis - May increase lipids (LDL by 15%) - Photosensitivity - Impotence
29
chlorthalidone dosing
12.5-25mg QD
30
Beta blocker MOA
Beta receptors of heart: - Competitive inhibition of Beta receptors - Decreases HR & contractility Beta receptors of kidney: - Decreases renin secretion
31
Beta blocker role in therapy
- Preferred for white>AA & young>old - Added benefits in pts with: ischemic heart dz/MI, migraines/tachyarrhythmias, tremor, diastolic CHF, systolic CHF (cautious use)
32
Beta blocker cautious use in pts with:
- DM - Severe PAD - Bradycardia - Asthma/COPD
33
propranolol (Inderal/LA) dosing
160-480mg BID | 80-320 mg QD
34
Beta blocker adverse effects
- CNS depression - Cardiovascular - Hyper/hypoglycemia (can mask hypoglycemic episodes) - Increase triglycerides - Bronchospasm (cautious use in asthmatics) - Peripheral vascular effects (cautious use in pts w/ PAD) - Sexual dysfunction - Withdrawl syndrome (titrate slowly)
35
Calcium channel blockers MOA
- Decrease influx of Ca into vascular smooth muscle resulting in vasodilation & reduced SVR
36
Calcium channel blocker role in therapy
- Equal efficacy in AA & whites - better in elderly Added benefits in pts w/: - Ischemic heart dz/MI - Diastolic CHF - Asthma
37
DHP CCB
amlodipine (Norvasc), nifidepine (Adalat CC, Procardia) - | increase HR, +++ vasodilation (minimal lowering of CO, contractility)
38
Calcium channel blocker adverse effects
- HA - Peripheral edema - Palpitations (DHP) - Constipation (verapamil) - Bradycardia (non-DHP) - GERD exacerbation
39
nifedipine (Adalat CC, Procardia XL) dosing
DHP CCB | 30-60mg/day
40
Alpha-1 blockers MOA
vasodilation &decrease SVR from competitively blocking post-synaptic alpha 1 receptors
41
Alpha-1 blockers role in therapy
- 2nd line - Effective in combo - May improve lipid profile - May improve insulin sensitivity - Tolerance possible - May improve BPH symptoms
42
Alpha-1 blocker adverse effects
- 1st dose syncope, orthostasis - HA - Possible urinary incontinence
43
doxazosin (Cardura) dosing/admin
1-16mg/day QD Alpha-1
44
Central sympatholytics MOA:
Stimulates pre-synaptic alpha-2 receptors, decreasing release of neurotransmitter & amp; decreasing sympathetic outflow resulting in vasodilation
45
Central sympatholytics role in therapy
- not first line - Avoid using w/ alpha blocker - Topical admin w/ patch available
46
Central sympatholytics adverse effects
- methyldopa may decrease HDL & increase TG, make ANA positive - Rebound HTN (titrate down to d/c) - Sedation - Drym mouth - Constipation - Sexual dysfunction - Bradycardia - Depression, drug-induced liver dz
47
clonidine (Catapres/TTS) dosing
0.1-0.8mg/day BID 0.1-0.3 mg/day once weekly Central sympatholytic
48
ACE Inhibitors MOA
Inhibits conversion of angiotensin I to angiotensin II (angiotensin II is potent vasoconstrictor & stimulates aldosterone secretion) ACE reduces both preload & afterload
49
ACE inhibitor rol in therapy
- Diabetic nephropathy - CHF - post MI
50
ACE adverse effects (7)
- Hypotension - Hypokalemia - Cough - Acute renal failure - Angioedema - Taset distrubances - Contridicated in pregnancy
51
lisinopril (Prinivil) dosing
10-40 mg/day QD ACE Inhibitor
52
Angiotensin II receptor antagonist MOA
vasodilation Blocks the effect of angiotensin II (vasoconstrictor) @ receptor, thus causing
53
Angiotensin II receptor antagonist role in therapy
- more efficacious in whites>blacks - synergy w/ diuretics - useful in DM pts
54
Angiotensin II receptor antagonist adverse effects
- Hyperkalemia - Acute renal insufficiency - Contraindicated in pregnancy NO cough or taste disturbances & lower risk of angioedema
55
losartin (Cozaar) dosing
25-100mg/day QD/BID Angiotensin II receptor antagonist
56
Direct renin Inhibitor MOA
Directly inhibits the binding of renin to angiotensinogen, thus decreasing plasma renin activity by 50-80% & prevening conversion to angiotensin I
57
Direct renin inhibitor role in therapy
- TBD | - BP reduction SBP 10-15 mmHg & DBP 8-10mmHg
58
Direct renin inhibitor pharmacokinetics
- oral bioavailability: 2.5% - 25% eliminated in urine - t1/2 = 24 hours - Max BP reduction w/i 2 wks
59
Direct renin inhibitor adverse effects
- Diarrhea - Hyperkalemia - Increased CK - Cough (less than ACE) - Rash - Hyperuricemia - Contraindicated in pregnancy
60
aliskiren (Tekturna) dosing/admin
150-300mg QD | Direct renin inhibitor
61
Direct acting vasodilator MOA
- Decreased SVR via direct arterial vasodilation - NO venous effect - Potent vasodilation stimulates renin secretion - Activation of baroreceptor reflexes stimulates reflex tachycardia
62
Direct acting vasodilator role in therapy
- NOT first line - May decrease DBP>SBP - Pts w/ heart failure: possible benefit in combo w/ nitrates - Useful in pts w/ renal insufficiency
63
Direct acting vasodilator adverse effects
- orthostasis - tachycardia - lupus-like syndrome (hydralazine) - hirsutism (minoxidil)
64
minoxidil (Loniten) dosing
minoxidil (Loniten): 2.5-80mg/day QD/BID | Direct acting vasodilator
65
Peripheral adrenergic inhibitors MOA
- Decreased release of catecholamines in peripheral sympathetic nerve endings - Decreased peripheral vascular resistance, HR & CO
66
Peripheral adrenergic inhibitors role in therapy
Refractory HTN
67
Peripheral adrenergic inhibitor adverse effects
- orthostatics - pseudotolerance - depression - sexual dysfunction/impotence - nasal congestion & increased gastric acid secretion (reserpine) - diarrhea - bradycardia
68
guanadrel (Hylorel) dosing
20-100mg BIDperipheral adrenergic inhibitor dosing/admin
69
atenolol (Tenormin) dosing
25-100mg BID - B1 selective
70
carvedilol (Coreg) dosing
12.5-50mg BID - A1 inhib
71
labetalol (Trandate/Normodyne) dosing
200-800mg BID - A1 inhib
72
metoprolol (Lopressor/(Toprol XL) dosing
B1 selective 25-100mg QD 25-100mg BID
73
hydrochlorothiazide dosing
``` 12.5mg/day = 85% max effect 25mg/day = 95% max effect >25mg/day = same effect + more adverse effects ```
74
non DHP CCB
verapamil (Calan), diltiazem (Cardizem) - | decreases HR, CO & contractility, ++ vasodilation
75
captopril (Capoten) dosing
ACE inhib
76
diltiazem (Cardizem LA) dosing
Non DHP CCB
77
hydralazine (Apresoline) dosing
direct acting vasodilator
78
enalapril (Vasotec) dosing
ACE inhibitor
79
prazosin (Minipress)
2-20mg
80
verapamil (Calan, Isoptin) dosing
nonDHP CCB
81
reserpine dosing
peripheral adrenergic inhibitor
82
guanethidine (Ismeilin)
peripheral adrenergic inhibitor
83
amlodipine (Norvasc)
DHP CCB

Pharmacology (10 decks)

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